Provider Demographics
NPI:1104137686
Name:BADOLATO, KEVIN ARTHUR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ARTHUR
Last Name:BADOLATO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:817 FEDERAL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1539
Mailing Address - Country:US
Mailing Address - Phone:856-583-2415
Mailing Address - Fax:856-541-3340
Practice Address - Street 1:817 FEDERAL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1539
Practice Address - Country:US
Practice Address - Phone:856-583-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09257600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0362174Medicaid